Dressing and Care for Post-MOHS Surgery Wound: Expert Guidelines for Optimal Healing
Consistent dressing changes and moisture control foster a quick, seamless recovery.
Table of Contents
- Introduction
- Why MOHS Surgery?
- Initial Dressing and Care
- Daily Dressing Changes
- Wound Hygiene
- Antibiotic Ointment Use
- Moisture and Bandaging
- Pain and Swelling Management
- Possible Complications and When to Call Your Doctor
- Scar Management and Sun Protection
- Frequently Asked Questions (FAQs)
- Conclusion
Introduction
MOHS micrographic surgery is a highly effective treatment for certain types of skin cancer, offering the highest cure rates while preserving as much healthy tissue as possible. The procedure involves removing thin layers of skin, which are examined under a microscope in real time, until no cancer cells remain. While the surgical technique is minimally invasive, proper post-operative wound care is crucial for optimal healing, infection prevention, and the best cosmetic outcome.
Why MOHS Surgery?
MOHS surgery is primarily used to treat basal cell carcinoma and squamous cell carcinoma—two of the most common types of skin cancer. Its advantages over traditional surgical excision include
- Precision: The surgeon examines each layer of removed tissue under a microscope, ensuring complete tumor removal while sparing healthy tissue.
- High Cure Rate: MOHS surgery boasts one of the highest cure rates for skin cancer.
- Cosmetic Benefit: This method minimizes scarring and maximizes tissue preservation.
- Outpatient Procedure: Most patients go home the same day.
Initial Dressing and Care
Immediately after MOHS surgery, your dermatologist will cover the surgical site with a sterile dressing or bandage. This initial dressing is critical for absorbing any oozing, protecting the wound from contamination, and minimizing the risk of infection.
How Long Should the Dressing Stay On?
Guidelines vary slightly depending on the practice, but most recommend leaving the initial dressing undisturbed for 24 to 72 hours. Some doctors specify 48 or 72 hours for certain types of wounds—always follow your surgeon’s specific instructions.
Protecting the Dressing
Keep the bandage dry—avoid showering, swimming, or exposing it to water during this period. If you must shower, cover the bandage with plastic wrap or a waterproof dressing to protect it. Moisture can increase the risk of infection and delay healing.
When to Remove the Initial Dressing
After the recommended period (e.g., 24 to 48 hours), gently remove the initial dressing. If you notice excessive bleeding, oozing, or any sign that the dressing has become wet, call your dermatologist for advice—you may need to change the dressing sooner.
Daily Dressing Changes
After removal of the initial dressing, daily wound care is essential. Here’s a step-by-step guide to changing your dressing properly:
- Wash Your Hands: Always wash your hands thoroughly before and after touching your wound to prevent infection.
- Remove the Old Dressing: Gently peel off the old gauze, telfa, or bandage. If the dressing sticks, moisten it with water to reduce pain and avoid damaging the healing tissue.
- Clean the Wound: Gently wash the area with mild soap and water. You can use a sterile gauze or Q-tip to remove crusting or drainage. Some doctors recommend cleansing with a mixture of equal parts water and hydrogen peroxide, but others advise against it—always follow your provider’s instructions.
- Dry the Area: Pat the wound dry with clean gauze or a dry cloth—do not rub, as this may irritate the healing skin.
- Apply Ointment: Apply a thin layer of antibiotic ointment (e.g., Mupirocin, Gentamicin, or plain petroleum jelly/Vaseline) if recommended by your doctor. Avoid Neosporin, which can cause allergic reactions in some people.
- Cover the Wound: Place a clean non-stick dressing (such as Telfa, gauze, or a Band-Aid) over the wound. If the wound is large or draining, add extra gauze. Secure the dressing with paper tape.
- Repeat Daily: Repeat this process once or twice daily as instructed by your surgeon, usually for 5–7 days.
- Gradual Reduction: After the initial 5–7 days, daily washing with soap and water is sufficient—usually, you can stop using ointments at this point.
Wound Hygiene
Proper hygiene is crucial for preventing infection and promoting healing. Here are key points to remember:
- Clean Hands: Always wash your hands before touching your wound or changing your dressing.
- Gentle Cleansing: Use mild soap and water. Do not use alcohol, hydrogen peroxide (unless your doctor specifically advises it), or harsh soaps on the wound, as these can damage healing tissue.
- Avoid Scratching or Picking: Itching is common during healing, but scratching can introduce bacteria and delay healing. Contact your doctor if itching is severe.
Antibiotic Ointment Use
Antibiotic ointments like Mupirocin or Gentamicin may be prescribed to prevent infection. Plain petroleum jelly (Vaseline) is an alternative for those with sensitive skin or antibiotic allergies. Apply a thin layer with a clean Q-tip to keep the wound moist, which promotes faster healing and reduces scab formation.
Moisture and Bandaging
Keeping the wound moist (not wet) is essential for optimal healing and to minimize scarring. A moist healing environment allows skin cells to move across the wound more efficiently and reduces scab formation, which can slow healing and increase scarring.
- Moisturize: Use the ointment recommended by your doctor until the wound is mostly healed.
- Change Dressing Regularly: Moist, occluded dressings should be changed daily to prevent maceration (overly soggy skin) and infection.
- When to Cover: Cover the wound with a dressing whenever you are outside or in a dirty environment. Indoors, it’s often safe to leave the wound uncovered.
Pain and Swelling Management
Some discomfort, swelling, and redness are normal after MOHS surgery, especially in the first 48 hours. Here’s how to manage these symptoms:
- Ice Packs: Apply an ice pack (wrapped in a clean cloth) over the bandage for 15 minutes on, 15 minutes off, for a few hours on the first day to reduce swelling.
- Pain Relief: Over-the-counter pain relievers such as acetaminophen (Tylenol) can be used as directed. Avoid aspirin, ibuprofen, or other NSAIDs unless specifically prescribed, as they may increase the risk of bleeding.
- Rest and Elevate: Keep the surgical area elevated if possible, especially if swelling is significant.
Possible Complications and When to Call Your Doctor
While most MOHS surgery wounds heal smoothly, complications can occur. Know the warning signs and when to seek medical attention:
| Sign | Normal | Concerning |
|---|---|---|
| Swelling | Peaks at 48 hours, mild to moderate | Severe, rapidly increasing, or spreading beyond the surgical site |
| Pain | Mild to moderate, improves with time | Severe, worsening, or sharp pains |
| Bleeding | Small amount of oozing for the first few days | Persistent or heavy bleeding after 30 minutes of direct pressure |
| Redness | Mild, localized | Spreading, hot to touch, or with red streaks |
| Drainage | Small amount of clear or slightly yellow fluid | Thick, green, foul-smelling, or increasing drainage |
| Fever | None | Fever ≥100.4°F (38°C) |
If you experience severe pain, signs of infection, persistent bleeding, or any symptoms that concern you, contact your dermatologist immediately or seek emergency care if needed.
Scar Management and Sun Protection
Healing after MOHS surgery usually leaves a scar. Proper care can help reduce its visibility:
- Sun Protection: The new skin is especially sensitive to sunlight. Always keep the area covered or use a broad-spectrum sunscreen (SPF 30 or higher) once the wound is fully healed.
- Scar Massage: Massaging the scar gently after sutures are removed (typically 6 weeks post-surgery) can help flatten and soften it.
- Creams and Oils: Ask your dermatologist about scar-reducing creams or silicone sheeting if desired.
- Patience: Scars may appear pink or red for several months before fading to white. Full maturation can take up to a year.
Frequently Asked Questions (FAQs)
Q: How long should I keep the initial dressing on after MOHS surgery?
A: Most guidelines recommend leaving the initial dressing in place for 24 to 48 hours, though your doctor may specify a different time. Always follow your surgeon’s instructions.
Q: When can I shower after MOHS surgery?
A: You can generally shower after removing the initial dressing (after 24–48 hours), unless your doctor advises otherwise. Avoid getting the wound wet until that point—cover the area with plastic wrap if necessary.
Q: Should I use hydrogen peroxide to clean my wound?
A: Some doctors recommend diluted hydrogen peroxide for initial cleaning, but others avoid it because it can be too harsh for healing skin. Always follow your provider’s instructions.
Q: How often should I change my dressing?
A: Change the dressing once or twice daily as directed by your doctor, usually for 5–7 days, then switch to daily washing with soap and water.
Q: What should I do if I notice signs of infection?
A: If you notice spreading redness, increased pain, swelling, pus, foul odor, or fever, contact your dermatologist immediately.
Q: How can I minimize scarring after MOHS surgery?
A: Keep the wound clean and moist, avoid sun exposure, and consider scar massage or silicone treatments once the wound is healed. Discuss options with your dermatologist.
Q: Is it normal to feel numbness around the surgical site?
A: Yes, temporary numbness is common and may last up to 6 months as nerves heal. Consult your doctor if sensation does not return over time.
Conclusion
Proper care of your post-MOHS surgery wound is critical for healing, minimizing infection risk, and achieving the best cosmetic result. Follow your dermatologist’s specific instructions, keep the wound clean and moist, and monitor for any signs of complications. With attentive care, most patients experience excellent healing and minimal scarring after MOHS surgery.
If you have questions or concerns about your recovery, never hesitate to contact your healthcare provider—they are your best resource for ensuring a smooth and successful healing journey.
References
- https://www.bluewaterderm.com/wp-content/uploads/2017/08/Mohs-and-Excision-Wound-Care-Instructions.pdf
- https://feinsteindermatology.com/care-instructions/mohs-and-se/
- https://midlandtxdermatology.com/mohs-surgery-post-op/
- https://dermatologyseattle.com/how-long-do-i-wear-a-bandage-after-mohs-surgery/
- https://www.uclahealth.org/sites/default/files/documents/MohsFAQsFinal.pdf?f=330e750b
- https://mydoctor.kaiserpermanente.org/ncal/article/wound-care-instructions-after-mohs-surgery-with-no-sutures-dsa-plastic-surgery-1556144
- https://www.mtlda.com/blog/how-to-care-for-your-skin-after-mohs-surgery
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